Type 1 diabetes (T1D) is one of the most common pediatric chronic illnesses. Glycemic control among patients with T1D often deteriorates during adolescence; yet little is known about the most effective way for providers to communicate with adolescents to prevent this decline. Given the importance of effective communication, examination of effective patient-provider communication strategies is needed. The current investigation used Motivational Interviewing (MI) as a framework to help characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined the relations between provider communication and T1D self-management and control. Participants were five pediatric endocrine providers and 55 adolescents with T1D (49% female; 76% White; M age= 14.8 years, SD= 1.6). Mean T1D duration was 7.9 years (SD= 3.9) and mean baseline HbA1c was 8.58% (SD= 1.4). Adolescents and caregivers completed surveys related to diabetes self-management and psychosocial functioning at a routine endocrinology visit and again at one and three months post-baseline. Medical encounters were audio-recorded and coded. HbA1c was obtained via medical chart review at baseline, three, and six month appointments. Hierarchical multiple regressions revealed that, after controlling for prior MI training (providers) and adolescent baseline HbA1c, age, and race, use of MI non-adherent behavior (e.g., confronting, persuading) was associated with 1) poorer three month HbA1c, F(5,45)= 11.19, p < .001; R2 = .554 and 2) worse adolescent diabetes adherence, F(5, 46)= 9.86, p < .001; R2= .517. MI non-adherent behavior emerged as a significant predictor in each model, t(45)= 2.13,p = .038, β = .242 and t(46) = -2.39, p= .021, β= -.300, respectively. A mediation analysis determined that patient self-efficacy for diabetes self-management mediated the relation between the use of these MI non-adherent behaviors and lower diabetes adherence. In TalkT1me, providers’ overreliance on persuasion and confronting adolescents about the risks of non-adherence was paradoxically associated with poorer glycemic control and adherence. Certain communication techniques that are inconsistent with MI, like confronting or persuading, appear to have a negative impact on diabetes self-care and HbA1c. Results from this evaluation of naturally occurring communication can help guide targeted training efforts to enhance communication and improve diabetes self-care with these vulnerable patients.

The goal of this research was to uncover the needs of adolescents, who had been orphaned by the death of both parents. The intention was to search for a deeper understanding of the needs of such adolescents, as well as to identify and discuss how service rendering to them can be improved. Therefore the research focused on adolescence as a developmental stage in the life-cycle and the impact of death on adolescents who have been orphaned by both parents. To attain and enhance the goal, empirical research was conducted by means of semi-structured interviews with male adolescents who have lost both parents. The research findings highlighted the final phases of the physiological, psychological, brain and moral development towards adulthood. It uncovered the devastating effects such as numbness and emotional exhaustion that death of both parents, may have on these children. The research indicated the negative effects of this trauma on their communication skills, pain, and feelings of loss, guilt and vulnerability. Furthermore, the research confirmed the fact that they are left alone without parents a factor which pushes them into adulthood before they are ready for it. The research uncovered further needs these children may have for example good care, the need to have a guardian, protection, education, support, a place to stay, toiletries, clothes, food, information about how to date girls and to show respect to others. These findings lead the researcher to formulate several recommendations. It is clear those social workers as well as all the other professionals who work in this field of practice need to understand the needs of adolescence as developmental phase. Training in this regard should thus include the life cycle with special reference to adolescence, the impact of death on adolescents and their special needs. Finally, it is clear from the study that the principle of the best interest of the child, should always be taken in consideration when any service is being rendered to these children. / Dissertation (MSW)--University of Pretoria, 2013. / Social Work and Criminology / unrestricted

In Taiwan, the running race has become a prevalent physical activity (PA) over the past decade. A personalized running program, Run-Up, is a middle distance running unit that integrates a series of educational activities into an existing high school physical education (PE) course for enhancing students’ efficacy beliefs and enjoyment of running. Self-efficacy theory (SET) provided a framework to help the researcher understand how and why the Run-Up program activities affect students’ efficacy beliefs and perspectives on running. This qualitative case study was designed to explore the effectiveness of the Run-Up program in promoting high school students’ self-efficacy and enjoyment of a middle distance running in a single class of grade twelve students in Taiwan. Data collection methods included semi-structured interviews with students and the teacher, their course feedback forms, and the samples of their journal entries including the students’ course work and teacher’s teaching notes. Data were analyzed by using constant comparison. Three resulting themes explicated how diverse learning activities integrated with multiple learning strategies in the Run-Up program could serve as an avenue to foster high school students’ self-efficacy and enjoyment of running. Comments from both the teacher and students highlighted the value of the Run-Up program as an educational PA program. / Graduate

The purpose of the present dissertation was to evaluate the internal validity of symptoms of four common anxiety disorders included in the Diagnostic and Statistical Manual of Mental Disorders fourth edition (text revision) (DSM-IV-TR; American Psychiatric Association, 2000), namely, separation anxiety disorder (SAD), social phobia (SOP), specific phobia (SP), and generalized anxiety disorder (GAD), in a sample of 625 youth (ages 6 to 17 years) referred to an anxiety disorders clinic and 479 parents. Confirmatory factor analyses (CFAs) were conducted on the dichotomous items of the SAD, SOP, SP, and GAD sections of the youth and parent versions of the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV: C/P; Silverman & Albano, 1996) to test and compare a number of factor models including a factor model based on the DSM. Contrary to predictions, findings from CFAs showed that a correlated model with five factors of SAD, SOP, SP, GAD worry, and GAD somatic distress, provided the best fit of the youth data as well as the parent data. Multiple group CFAs supported the metric invariance of the correlated five factor model across boys and girls. Thus, the present study’s finding supports the internal validity of DSM-IV SAD, SOP, and SP, but raises doubt regarding the internal validity of GAD.

Susceptibility to smoking has been widely measured in an effort to detect those teens who lack of a firm commitment to not smoke. This measure, however, has not been applied to Chinese-Canadian adolescents. The overall goal of this study was to understand susceptibility to smoking among Chinese-Canadian non-smoking teens. The dissertation includes three papers, each of which has addressed one of the three primary aims of this study. The first paper aims to document the prevalence of susceptibility to smoking among a sample of non-smoking teens in British Columbia, Canada, and to examine the factors that explain the variation in susceptibility to smoking. I employed a quantitative secondary analysis of data from the BC Youth Survey of Smoking and Health. More than one quarter of the respondents were found to be susceptible. The Chinese-Canadian adolescents appeared to have a similar rate of susceptibility to smoking as their White/Caucasian counterparts, even though the smoking prevalence was lower among Chinese-Canadian group than in White/Caucasian group. In the second paper, I explored non-smoking Chinese-Canadian adolescents’ views about the protective factors and the risk factors that might lead them to be susceptible to smoking. In this paper I report an analysis of four qualitative focus groups which included 24 Chinese-Canadian participants. Negative attitudes toward smoking, befriending non-smoking teens, being peer pressured not to smoke and a collectivist cultural perspective were identified as protectors that helped Chinese Canadian teens remain tobacco free in their adolescence. The teens argued that authoritarian parenting had both positive and negative effects on Chinese teens’ susceptibility to smoking. These findings enhanced our understanding of the role that an ethnic group’s culture might play in adolescent smoking. In the third paper, I use Chinese-Canadian teens’ perspectives to reconsider the operationalization of the measure of susceptibility to smoking. Avoiding absolute answers was viewed by the participants as a unique cultural style among Chinese-Canadian teens. They also commented on the ambiguity of using the term “smoking” in the smoking susceptibility measure. Further research is needed to gain a better understanding of the operationalization of the measure in this cultural group. / Applied Science, Faculty of / Nursing, School of / Graduate

While numerous studies have linked family routines to pediatric asthma outcomes, it remains unclear how family routines come to be associated with these outcomes on a biological level. The current study investigated whether longitudinal trajectories of inflammatory markers of asthma could be predicted by levels of family routines in youth with asthma. Family routines were assessed at baseline through parent questionnaires and peripheral blood samples obtained from youth every 6 months (total number of assessments = 4) over the course of an 18 month study period. Youth with more family routines in their home environment showed decreases in mitogen-stimulated production of a cytokine implicated in asthma, IL-13, over the course of the study period. In turn, within-person analyses indicated that at times when stimulated production of IL-13 was high, asthma symptoms were also high, pointing to the clinical relevance of changes in IL-13 over time. A variety of potential explanations for this effect were probed. Parental depression, stress, and general family functioning could not explain these effects, suggesting that family routines are not just a proxy for parent psychological traits or family relationship quality. However, medication use eliminated the relationship between family routines and stimulated production of IL-13. This suggests that family routines do impact asthma outcomes at the biological level, possibly through influencing medication adherence. Considering daily family behaviors when treating asthma may help improve both biological and clinical profiles in youth with asthma. / Arts, Faculty of / Psychology, Department of / Graduate

Research shows that teens (Generation Z) are not as information literate as required to function effectively in an information society. Yet many teens are gamers and succeed at game-related tasks that require information literacy skills. This thesis examines the potential that the online game Minecraft, and one of its related affinity spaces, may have in the development of information literacy skills in teens. This case study unfolded in three phases: a video game analysis of Minecraft, a discussion forum analysis and an interpretive report of interviews with eight teen gamers. Findings suggest that Minecraft’s design induces players to seek out game related information in affinity spaces, select appropriate sources, evaluate the information shared by fellow gamers and decide what best satisfies their information need. Further research could determine whether the specific information literacy skills in this gaming context can be generalized to other gaming environments and to non-gaming contexts.

Parenting is one of the most influential as well as modifiable factors influencing healthy child development (Grusec, 2011; Sanders, 2012). This dissertation includes two studies that were designed to broaden our understanding of parenting in developmental periods widely recognized to present parenting challenges: Study 1 focused on the toddler and preschool years (Crnic & Low, 2002; Kwon, Han, Jeon, & Bingham, 2013) and Study 2 focused on adolescence (Eisenberg et al., 2008; Laursen & Collins, 2009). Both studies involve analysis of data on self-reported parenting responses and parenting goals, as well as parent-rated child adjustment from community samples of mothers and fathers. In the first study parenting similarity in the parenting responses and parenting goals of mothers and fathers of toddlers and preschoolers were examined. As well, I examined whether these were linked to parents’ ratings of their children’s adjustment on the Child Behavior Checklist Preschool form (Achenbach & Rescorla, 2000). In addition, I examined whether there were differences between parenting situations involving child misbehaviour and child withdrawn behaviour. Participants were 148 families of children aged between 18 months and 60 months. Parenting similarity was found both for parenting responses and for parenting goals. However, neither similarity in parenting responses or parenting goals differed for situations involving child misbehaviour versus child withdrawn behaviour. Furthermore, parenting similarity in parenting responses and parenting goals were not found to be related to each other or to child adjustment. The second study was conducted with mothers and fathers of adolescents and was designed to extend on the work of Hastings and Grusec (1998). In this study I also examined parenting similarity in parenting responses and parenting goals. Participants were 285 parents of adolescents aged 14 to 17 years old (mothers n = 213, fathers n = 68, dyads n = 43). Parenting goals were influenced by characteristics of the situation, but not by parent or adolescent gender. Parenting goals were not related to parents’ ratings of their adolescent children’s adjustment on the Child Behavior Checklist School Age form (Achenbach & Rescorla, 2001). As in the first study, I found parenting similarity for parenting responses and parenting similarity for parenting goals, but the two types of similarity were not related to each other. The findings with respect to parenting goals indicate that there is insufficient evidence to justify future parenting goals studies given the limitations of the extant methodology for measuring them. Future parenting similarity studies that use statistical analyses, such as cluster analyses, that allow for the examination of the links between specific parenting similarity (e.g., having two parents that are authoritative vs. two that are authoritarian) and child adjustment hold promise for informing clinical practice with families.

Class of 2017 Abstract / Objectives: The purpose of the study was to identify the types of motivation that promote sustained physical activity among adolescents between the ages of 11-17 who are diagnosed with type 1 diabetes (T1D) to prevent diabetes related complications. Methods: Questionnaires were distributed and collected among the Juvenile Diabetes Research Foundation’s (JDRF) listserv, Facebook page, and events in Phoenix and Tucson, Arizona on motivations for managing diabetes and exercise and confidence in diabetes management and performing physical activity. Demographic data was collected on age, gender, and race/ethnicity. Physical activity, levels of activity intensity, weight, height, health- related risk behaviors, chronic health conditions, and use of preventative services were also included in this study. Results: 11 adolescents completed questionnaires, categorized by participants who exercise less than 60 minutes daily (Group below recommended exercise level, GBRE) and participants who exercise more or equal to 60 minutes daily (Group meeting recommended exercise level, GMRE). GBRE’s average mean age was 15.75 and GMRE’s average mean age was 13.92. GMRE was associated with higher intensity physical activity (42.85% versus 0%). GBRE had a relative autonomy index (RAI) of 1.67 on the Treatment Self-regulation Questionnaire (TSRQ) compared to GMRE with a RAI of 3.81 (Mann-Whitney U 19, p-value 0.412). GBRE scored 73.75 on the Diabetes Self-efficacy Scale (DSES) and GMRE scored 78.71 (Mann-Whitney U 7, p-value 0.23). Conclusions: Adolescents who exercised ≥ 60 minutes daily were observed to be self-motivated in managing their diabetes, especially maintaining exercise recommendations to decrease diabetes related complications.

The growth of consumerism has meant that individuals are increasingly using possessions as a means of developing their personal identities and forming social connections. Specifically, the consumer culture has seen the increase of brands and branded goods as marketers attach emotional attributes to them. Thus, brands have become communicative symbols which display, amongst other things, the owner's values, beliefs and social status. As a result, consumers are attempting to form their identities, social connections and self-worth by consuming (often branded) possessions which they feel are representative of their self or ideal self and will increase their chances of social acceptance. However, psychological studies in consumer behaviour suggest that the increasing propensity to seek inner happiness and social bonds through external means (consumption), has led consumers to be less satisfied with their lives and hence decreases psychological well-being; the focus on external rewards has reduced the importance that individuals place on personal development and intrapsychic developments.This study investigates the relationship between the consumption culture, branding and British adolescents, with a comparison between high and low-income teenagers. Adolescents are particularly prone to assuming consumer orientations (and hence the consequences thereof) due to their stage in identity development, their need for social acceptance and the fact that they are a very profitable market segment. As a result, teenagers are encouraged to turn to consumption for developing their personal and social identities, as opposed to more traditional means such as personal skill development. Although limited studies have investigated adolescent consumption, little attention has been paid to low-income adolescents who are prone to reduced self-worth but have a restricted consumption scope and thus cannot consume their self-worth in the same 'normal' ways as their peers. In light of previous studies, it was necessary to first develop a new measure of self-esteem which included the vital role of possessions (and specifically brands) in feelings of self-worth amongst adolescents. The scale-development process revealed the functional importance of self-esteem as a marker of social inclusion and hence shed light on the reason for the importance that adolescents place on specific brands; they are a promise of fitting-in. A valid and reliable 23-item, self-report measure of self-esteem is presented. Subsequent to developing the new scale, the research provided empirical support for a model of the psychological characteristics of adolescent consumption (including self-esteem). The result is a 'Vicious Cycle' model of consumption which suggests that there is a relationship between the factors which contribute to a consumer orientation and the likely effects of having such an orientation. For example, the model suggests that reduced self-esteem may contribute to consumerism and a consumption orientation may contribute to a reduction in self-esteem. Furthermore, the comparison between high and low-income teenagers showed that low-income teenagers were significantly more materialistic than their high-income counterparts thus supporting the suggestion that low-income teenagers are more prone to consumerism than their high-income counterparts. With reference to the detailed links presented in the Vicious Cycle model, the author proceeds to explore the efficacy of extant consumerist-curbing strategies and highlight the need for more effective methods if we wish future generations to develop in to more than simply shoppers.